Emerging Paradigms in Preventive Dentistry: A Review of Nonfluoridated Remineralizing Agents

Nonfluoridated remineralizing agents have gained significant attention as alternatives or adjuncts to fluoride for managing early caries and enhancing enamel health. This narrative review explores the composition, mechanisms of action, applications, and efficacy of various nonfluoridated remineralizing agents, including calcium phosphate-based systems, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), bioactive glass, hydroxyapatite nanoparticles, Galla Chinensis, theobromine, Enamelon technology, bamboo salt solution, grape seed extract, tricalcium phosphate, and titanium fluoride technology. The review is based on recent literature to provide a comprehensive overview of these materials and their clinical implications.

Dental caries remains one of the most prevalent oral diseases worldwide. Fluoride has been the cornerstone of caries prevention due to its well-documented ability to enhance enamel remineralization and inhibit demineralization. However, fluoride is often described as a double-edged sword. While its benefits in caries prevention are well-established, excessive fluoride exposure can lead to adverse effects such as dental fluorosis, enamel mottling, and systemic toxicity. These concerns are especially significant for young children, who are more vulnerable to fluoride ingestion. Consequently, there is a growing need to explore nonfluoridated remineralizing agents that can offer comparable efficacy without associated risks.

A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. The search included studies published between 2015 and 2024 to ensure the inclusion of recent advancements. Keywords such as "nonfluoridated remineralizing agents," "enamel remineralization," "CPP-ACP," "bioactive glass," "hydroxyapatite," "Galla Chinensis," "theobromine," "Enamelon technology," "bamboo salt solution," "grape seed extract," "tricalcium phosphate," and "titanium fluoride" were used. Articles were selected based on relevance, with emphasis on randomized controlled trials, in vitro studies, and clinical reviews. A total of 80 articles were initially screened, of which 20 were included in this review based on their relevance to the topic.

This review examines recent advancements in nonfluoridated remineralizing agents, their mechanisms of action, and their role in contemporary preventive dentistry. Evidence suggests that nonfluoridated agents play a promising role in promoting enamel remineralization and reducing demineralization without the concerns associated with fluoride toxicity. Further research is warranted to refine these technologies and establish long-term clinical outcomes.

Thomas NA, Thimmaiah C, Shinu BR, et al. Emerging Paradigms in Preventive Dentistry: A Review of Nonfluoridated Remineralizing Agents. Int J Clin Pediatr Dent 2025;18(11):1404-1406.